POS0302 TREATING SPONDYLOARTHRITIS EARLY: DOES IT MATTER? RESULTS FROM A SYSTEMATIC LITERATURE REVIEW
Authors: D. Capelusnik, D. Benavent, D. Van der Heijde, R. Landewé, D. Poddubnyy, A. Van Tubergen, L. Falzon, V. Navarro-Compán, S. Ramiro
Journal: Annals of the Rheumatic Diseases (2022)

Background So far, no consensus has been reached on a definition of early SpA. The ASAS-SPEAR (SPondyloarthritis EARly definition) project aims to develop a consensual definition. Therefore, it is important to know whether treatment earlier in the disease course compared to treatment of established disease leads to better outcomes in axSpA. Objectives To summarize the evidence on the relationship between symptom duration or the presence of radiographic damage and clinical response in patients with axSpA treated with NSAIDs, bDMARDs or tsDMARDs. Methods A SLR was conducted using Medline, EMBASE and the Cochrane Library (April 28, 2021), supplemented by hand-searches in the FDA website. Randomized controlled trials (RCTs) and cohort studies in patients with axSpA addressing the impact of symptom duration or disease duration and presence of radiographic damage on treatment response (to NSAIDs, b/tsDMARDs) were included. Based on a cut-off of symptom/disease duration or the absence/presence of radiographic damage, groups of ‘early’ and ‘established’ disease were compared. Treatment outcomes were measures of disease activity, function or quality of life. Two reviewers independently identified eligible studies and extracted the data, including the risk of bias (RoB) assessment. For categorical outcomes we calculated relative risk (RR), relative risk ratio (RRR) and number needed to treat (NNT), and differences in differences (DID) for continuous outcomes. Results From the 8769 articles retrieved, 23 were included and 3 added by hand-search, most of them with low RoB. Nineteen studies (9 RCTs) compared groups based on symptom (n=6)/disease duration (n=13) and 7 studies (4 RCTs) based comparisons on absence/presence of radiographic damage in posthoc analyses. When early axSpA was defined by symptom duration in RCTs (n=4), in patients with nr-axSpA, early treatment was associated with higher RR and RRR and lower NNT for ASAS40 in two studies (Table 1); a third study showed that patients achieving ASDAS-ID and ASAS-PR had shorter symptom duration than those not achieving this. Lastly, in one study including patients with axSpA patients, no difference in treatment response was observed based on symptom duration. In most of the cohort studies using a definition based on symptom/disease duration (n=10), no association was found between symptom/disease duration and treatment response (n=8). Only in one cohort study, disease duration was a significant predictor of quality of life, and in another cohort study, it was a predictor of functional improvement. Table 1. Assessment of treatment response in RCTs based on symptom duration Study Population Early vs established (years) RR (early vs established) RRR (95%IC) NNTs (early vs established) ASAS20 Landewé 2014 axSpA &lt;5 vs ≥5 1.5 vs 1.5 0.96 (0.53-1.73) 5.5 vs 4.8 ASAS40 Sieper 2012 nr-axSpA &lt;5 vs ≥5 8.2 vs 1.6 5.24 (1.12-24.41) 2.4 vs 9.1 Kay 2019 nr-axSpA &lt;5 vs ≥5 5.0 vs 3.3 1.52 (0.60-3.87) 2.1 vs 3.9 3.6 vs 3.5 1.01 (0.46-2.20) 2.1 vs 2.9 ASDAS-MI Kay 2019 nr-axSpA &lt;5 vs ≥5 5.1 vs 6.5 0.78 (0.19-3.16) 2.7 vs 4.9 7.1 vs 6.4 1.11 (0.34-3.66) 2.1 vs 3.0 Study Population Symptom duration p value Responders Non responders ASDAS-ID Sieper 2019 nr-axSpA 6.1±6.2 8.3±8.1 &lt;0.001 ASAS-PR Sieper 2019 nr-axSpA 5.3±5.7 8.0±7.8 &lt;0.001 Cell colours In favor of early disease In favor of establish disease Non significant When early axSpA was defined based on disease duration or the presence of radiographic damage, there was no significant difference in response to treatment between early and established axSpA. Conclusion Studies addressing treatment response based on symptom duration or radiographic damage in axSpA are scarce. When defining early axSpA based on symptom duration, in nr-axSpA, treatment with bDMARDs may lead to better outcomes compared to established axSpA whereas in axSpA there is no difference in response to treatment between early and established disease. When early axSpA is defined based on disease duration or radiographic damage, no differences in response to treatment are found between early and established disease. Acknowledgements The Assessment of Spondyloarthritis international Society (ASAS) supported Diego Benavent financially for this work. Disclosure of Interests Dafne Capelusnik Speakers bureau: Bristol Myers Squibb, Pfizer, Grant/research support from: Pfizer, Diego Benavent Speakers bureau: Janssen, Roche, Grant/research support from: Novartis, Désirée van der Heijde Consultant of: AbbVie, Bayer, BMS, Cyxone, Eisai, Galapagos, Gilead, Glaxo-Smith-Kline, Janssen, Lilly, Novartis, Pfizer, UCB Pharma Director of Imaging Rheumatology bv., Robert Landewé Consultant of: AbbVie, BMS, Galapagos, Gilead, GSK, Janssen, Lilly, Novartis, Pfizer, UCB, Denis Poddubnyy Speakers bureau: AbbVie, Bristol-Myers Squibb, Eli Lilly, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Biocad, Eli Lilly, Gilead, GlaxoSmithKline, Janssen, MSD, Novartis, Pfizer, Samsung Bioepis, and UCB, Grant/research support from: AbbVie, Eli Lilly, MSD, Novartis, and Pfizer, Astrid van Tubergen Consultant of: Novartis, Galapagos, Grant/research support from: Pfizer, UCB, Novartis, Louise Falzon: None declared, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Novartis, Sofia Ramiro Speakers bureau: Eli Lilly, MSD, Novartis, UCB, Consultant of: AbbVie, Eli Lilly, MSD, Novartis, Pfizer, UCB, Sanofi, Grant/research support from: AbbVie, Galapagos, Novartis, Pfizer, UCB